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AUTHORIZATION NOTICE <br />(Supplemental Form) <br /> <br />In order to properly evaluate your existing sewage system, the following <br />information will be necessary: <br /> <br />If your sewage system is less than five (five) years old, and we have <br />an approved record of the system, we can proceed without any further <br />action on your part. <br /> <br />If your sewage system is less than five (5) years old, and we do not <br />have a record of an approved installation of the system: <br /> or; <br />If your sewage system is more than five (5) years old or has not been <br />pumper within the last five years: <br /> <br />You must have the septic tank pumped, <br />Have the septic tank pumper complete the form below. <br />A field visit will be required, by the Sanitaraian to verify the <br />location and condition of the septic system. <br />If you have proof that your septic tank has been pumped within the <br />last five (5) years, sections a & b will not be required. <br /> <br />For SePtic Tank Pumper Use Only <br /> <br />APPROXI~ATE SIZE OF SEPTIC TANK: <br /> <br />IS TA~K IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />IS DRAINFIELD RACKING UP INTO TANK? <br /> <br /> If yes, explain; <br /> <br />SEPTIC TANK MATERIAL: Concrete <br /> <br />gallons <br />..YES; __~NO <br /> <br /> .Y~S; ~ .... NO <br /> <br /> YES; _____~NO <br /> <br />Steel ~ Other <br /> <br />DIAGlt~HOF HOUSE A~D <br />LOCATION OF TANK: <br /> <br />Septic Tank <br /> <br />3/82 ~ev 10/87 <br /> <br />W <br /> <br />BUILDING INSPEC3~'~WATu~ o~ Pu~ms~ .... <br /> <br /> <br />